Retina Congress 2009: ocular oncology

Abstract

This event marked the 27th Annual Meeting of the American Society of Retina Specialists, the 32nd Annual Meeting of The Macula Society and the 42nd Annual Meeting of The Retina Society. The scientific program included several important papers and posters in the area of ocular oncology. Many of the topics that were covered are likely to have an immediate impact on clinical management, including molecular prognostic testing and postradiotherapy outcomes in uveal melanoma, new treatments for radiation retinopathy and super-selective intra-arterial chemotherapy for retinoblastoma.

The Ocular Oncology program consisted of a 1-h paper symposium and a poster session. The paper session consisted of seven presentations. J William Harbour (Washington University School of Medicine, St Louis, MO, USA) presented results of a prospective study validating a 15-gene expression assay for predicting which uveal melanoma patients will develop metastatic disease [1]. The assay was performed using fine-needle aspiration biopsy specimens from almost 700 patients. Harbour provided data showing that the test is a highly accurate predictor of metastasis and that it was superior to chromosome 3 statuses, and stated that the assay is now commercially available. Frederick Davidorf (Ohio State University, Columbus, OH, USA) highlighted the potential use of the MET oncogene as a therapeutic target for uveal melanoma. He demonstrated that MET is activated in a significant proportion of uveal melanomas, most likely through indirect gene activation rather than copy-number alteration or gene mutation. He concluded that the inhibition of MET might be a useful therapeutic target [2]. James Augsburger (University of Cincinnati, Cincinnati, OH, USA) offered a critical review of the currently available peer-reviewed literature regarding metastatic surveillance testing in uveal melanoma patients [3,4]. This is a highly controversial topic owing to financial, medical and individual factors. He concluded that there is no compelling evidence supporting that surveillance testing, which was carried out in previous published studies, was beneficial in prolonging the survival of patients with metastatic uveal melanoma. Evangelos Gragoudas (Massachusetts Eye and Ear Infirmary, Boston, MA, USA) presented his long-term survival data in patients with uveal melanoma treated with proton therapy. Cumulative 15- and 20-year mortality rates were 26 and 27%, respectively. Although patients continued to be at risk of death owing to melanoma present more than 20 years after treatment, the annual rates dropped to less than 1% after 14 years [5]. Devron Char (Tumori Foundation, San Francisco, CA, USA) presented his long-term follow-up of uveal melanoma patients randomized to helium-charged particle therapy versus ¹²⁵I brachytherapy. In this series, the local control and survival rates were better among patients treated by charged particle therapy than those treated with brachytherapy. Char added that some ocular morbidity historically described as radiation toxicity is probably due to an inflammatory response to the radiated tumor [6]. Paul Finger (New York University, New York Eye and Ear Infirmary, New York, NY, USA) reported on his 3 years of experience with intravitreal Avastin^® (bevacizumab; Genentech, Inc., San Francisco, CA, USA) for maculopathy and optic neuropathy secondary to radiation. He suggested that radiation retinopathy and maculopathy are both related to the dose and dose rate of radiation administered to treat the tumor. Avastin decreased retinal and optic disc hemorrhage, exudates and edema, and it stabilized or improved vision in most cases [7]. David Abramson (Memorial Sloan-Kettering Cancer Center, New York, NY, USA) presented his 3 years of experience using super-selective ophthalmic artery infusion of chemotherapy for retinoblastoma. Some of the children were as young as 3 months old during the time of treatment, and some were treated in both eyes at the same session. He showed cases in which dramatic responses were observed in eyes with very advanced disease. No significant systemic complications were found [8,9].

The poster session consisted of ten posters covering a range of topics related to benign and malignant intraocular tumors. Among the more interesting posters, Arman Mashayeshi (Wills Eye Institute, Philadelphia, PA, USA) reported on the long-term follow-up and slow growth of choroidal nevi (Poster 103) [10]. Tim Murray (University of Miami, Miami, FL, USA) presented his data on the use of focal periocular delivery of the hypoxia agent 2-deoxy-d-glucose alone and as an adjuvant to chemotherapy for the treatment of advanced retinoblastoma (Poster 105) [11]. Jose Luis Diaz Rubio (Hospital Aranda de la Parra, Leon, Mexico) presented a case report of bevacizumab plus photodynamic therapy with Visudyne^® (verteporfin; Novartis, East Hanover, NJ, USA) for treatment of a circumscribed choroidal hemangioma (Poster 108) [12]. Even though only one case was presented, this may be a promising strategy in the occasional choroidal hemangioma that is not responsive to photodynamic therapy alone. Scott C Oliver (University of Colorado Denver, Denver, CO, USA) presented experimental work evaluating the use of vitreous substitutes to attenuate radiation to normal structures during plaque radiotherapy for uveal melanoma (Poster 109) [13]. In the past decade, the field of ocular oncology as all of medicine has been fast progressing to better understand the mechanisms involved in the disease progress and insights into alternative therapeutic approaches. This meeting portrayed this era of change, but also provided an opportunity to update concepts, redefine standards and prompt new questions to be answered by future studies yet to come.

Financial & competing interests disclosure

Zélia MS Corrêa is partially funded by the Quest for Vision Fund (Department of Ophthalmology, University of Cincinnati, OH, USA), Research to Prevent Blindness, Inc., Mary Knight Asbury Chair of Ocular Pathology and E Vernon and Louise Smith Fund. J William Harbour is the recipient of supporting grants from the National Eye Institute (R01 EY013169), the National Cancer Institute (R01 CA125970), Research to Prevent Blindness, Inc., Barnes-Jewish Hospital Foundation, the Kling Family Foundation, the Horncrest Foundation and the Tumori Foundation. J William Harbour and Washington University may receive income based on a license of related technology by the University to Castle Biosciences, Inc. This work was not supported by Castle Biosciences, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.